Which is the best mode of delivery? What about maternal choice?

Pregnant woman with earphones

Am carrying my first pregnancy and I am getting increasingly anxious about delivery. I have gotten mixed pieces of advice leading me to contemplate delivery by Cesarean Section. 

Many first time mothers-to-be have genuine concerns about delivery. The ready availability, of sometimes very subjective advice, from all sorts of people, doesn’t help the situation. You may get even more confused if clarity on the situation isn’t really forthcoming from your antenatal care provider.

The first thing to understand is that labor and vaginal delivery is a completely natural phenomenon. During pregnancy, the body goes through various biological adaptations. These changes occur in virtually every organ system, but more specifically in the pelvis. Eventual adjustments in the pelvic muscles, joints, and the birth canal finally enhance the spontaneous expulsion of the baby during birth. After delivery biological healing processes kick-in, leading to the return of normalcy, that in many ways is indistinguishable from the initial pre-pregnancy state.

But nature doesn’t always get it right. Many things can go wrong during pregnancy and in labor. Some complications will mean that an alternate mode of delivery must be sought. Hence the emergence of the Cesarean Section (CS), and the less talked about assisted vaginal deliveries with appropriate instruments. Over time, CS deliveries have increased compared with vaginal deliveries in terms of safety for both the mother and the baby. The debate rages on whether one is superior to the other, and whether the maternal choice can prevail in situations where there is no medical reason for a CS.

Towards the end of the pregnancy, a decision about the mode of delivery must be made. If your pregnancy has been completely uncomplicated, the default advice is to await the onset of labor and anticipate spontaneous vaginal delivery. The safety of vaginal delivery is proven. All that is required is appropriate monitoring to safeguard any unexpected eventualities. If there was, however, a complication that mandates delivery by CS, then this would be advised well in advance.

What about maternal choice?


This has come up over the years riding on arguments about autonomy and choice, and also from observed medical benefits following CS deliveries. There are also arguments against CS deliveries purely on maternal preferences, ranging from cost to surgery-related complications. But there is ample leeway for either camp, necessitating some medical jurisdictions to facilitate CS deliveries by choice.

The eventual decision on how to deliver will thus be guided by several factors. If making a choice for a CS without any medical reasons, have a candid discussion with your gynecologist. Be very clear about your reasons for choosing a CS delivery. Maintain some flexibility, and be ready to change your mind once you listen to the counter-arguments. The overriding goal is the safe delivery of your baby.

By: Dr. Murage
Emails: amurage@mygyno.co.ke

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